PUBLIC WEDNESDAY MO] 
USING, SEPTEMBER IBJi'm 
Yellow fever occurring in the midst of an 
outbreak of dengue may take on some of the 
characters of the latter epidemic, and hence 
confusion arises as to the nature of a given 
case. The diagnosis Is especially difficult 
when the well-known symptom of "black 
vomit'' occurs in a case of dengue. The two 
diseases are alike in that they flourish in hot 
countries and that the occurrence of frost 
instantly puts an end to them. Probably 
dengue is more susceptible to the advent of 
cold weather. Bnt the two diseases are vast- 
ly different In their mortality. The high 
mortality of yellow fever is well known; 
deaths from dengue are very rare, but they 
occur occasionally In the case of children «or 
when complications with other diseases 
arise. ( 
The germ of yellow fever is attracting a 
great deal of attention in the medical world , 
at present. Eighteen years ago Dr. Stern- 
berg, noyr Surgeon General, U. S. A., com- 
menced his bacteriologic investigations in 
this field. They were carried on in Havana, 
Rio de Janeiro, Vera Cruz and in Decatur, 
Ala. He found a bacillus which he called 
bacillus X, but as this bacillus could be 
demonstrated in only one-half of the un- 
doubted cases of yellow fever which he bad 
examined, he deemed it prudent not to as- 
sert a positive discovery of the yellow fever 
germ. Very recently, however, Dr. J. San- 
arelli, the Superintendent of the Institute of 
Experimental Hygiene at Montevideo, has 
announced that he has succeeded in Isolat- 
ing a bacillus from the blood and Internal 
tissues of yellow fever patients. He states 
that he has thus reproduced the disease in 
animals and also in the human subject. The 
Government of Uruguay appears to have 
been so convinced of the value of the discov- 
ery that, if we may believe the accounts, he 
has already been awarded a premium of 
810,000 for his research. Meantime Surgeon 
General Sternberg proposes Immediately to 
resume his investigation# and ascertain 
whether or not the bacillus described by 
Sanarelli Is not identical with the bacillus 
X. G. H. 
| 
DENGUE, 
THE FEVER NOW EPIDEMIC AT 
OCEAN SPRINGS. 
The Character of the Disease, and 
Its Relation to Other Well - known 
Fevers. 
PREPARED SPECIALLY FOR THE PUBLIC 
LEDGER. 1 
Out of 748 cases of the prevailing fever at 
Ocean Springs there have been about 10 
deaths, and of these probably not more than 
half were due to yellow fever. The coexist- 
ence of this dangerous disease with a wide- 
spread epidemic of dengue, an affection 
characterized by violent symptoms, but a 
very low mortality, naturally gives rise to a 
great deal of confusion, and, as In the pies- 
ent instance, makes the differential diagno- 
sis a rather difficult matter. 
Dengue has been described under the name 
of * 'breakbone fever* ' and "bilious re mitt 1 ng 
fever,'' and was so designated by Dr. Ben- 
jamin Bush, who furnished us with the first 
account wo have of the disease, which, 
strange to say, invaded Philadelphia In 178'), 
appearing almost simultaneously in India, 
In Cairo, in Egypt, and in Spain. It ap- 
peared hi Lima in 1818, In Suez In 182.». and 
again in the United States at. Charleston and 
Augusta in 18.50-1854. Within ten years It 
-was epidemic in Syria, Asia Minor, and in 
seaports of Greece and Turkey. The vi- 
cinity of New Orleans has twice before been 
infected, namely, in 1873 and in 1880. 
Dgngne is an infectious fever, of a distinct 
nature, and peculiar to warm climates, 
usually appearing late in the summer or 
early autumn. It is probably dependent 
on some germ as yet undemonstrated; bac- 
teria have been described in cases which , 
have been examined, and the present cases 
will be rigidly searched by our Government 
experts for the essential cause or germ of t his 
strange disease. It attacks a large propor- 
tion, sometimes three-fourths,of the inhabi- 
tants of the invaded districts. 
In this and in various respects dengue re- 
sembles grippe or epidemic influenza. I he 
onset of the attack is sudden, frequently at 
night, and marked by pains and a feeling of 
stiffness in the muscles, Joints, back and 
loins, and even the bones. It was this latter 
symptom that gave it the early name of 
"breakbone fever.'' It resembles in this 
respect an acute attack of rheumatism. A 
patient may rise in the morning apparently 
as well as usual and begin to dress, but become 
so prostrated by pain and fever that 
further exertion is impossible and he will 
have to crawl back to bed. Slight chilliness 
may ensue, the eyes become injected and 
the skin dry and congested, so as to create a 
slight rash. Headache sets in and the tem- 
perature rises in severe cases to 103 degrees, 105 
degrees or 106 degrees Fahrenheit. Various 
other symptoms, which it is not neeessarj' 
here to state, accompany the salient fea- 
tures mentioned. The attack is short, sharp 
and decisive; the incubation period is from 
one to three days, and the average duration 
of the illness three to six days. Belapses 
i may occur and even third attacks have been 
recorded in the same epidemic, but usually 
• susceptibility ceases after one attack.